Why does a dentist perform perioprobing?


Every now and then patients ask a probing question. No not the type a 60 minutes reporter might ask, but they want to know why dentists probe their gums? Dentists  perform periodontal probing to measure the depth of the sulcus adjacent to teeth. Usually the area around the tooth is divided into 6 probable spots, )The mesio-buccal, cervical buccal, the disto buccal, mesio lingual, cervical lingual and disto buccal) That doesn't mean the dentist doesn't probe more of the surface adjacent to teeth, but usually they only call out 6 numbers for each tooth to be recorded. Assuming that a patient has 28 teeth, their perio chart will have 168 numbers recorded.

Dentists perform this prcoedure for a number of reasons. First to access the periodontal health of the area around a patients teeth. Readings of 1- 3 mm are considered normal. Pockets of 5 or more are usually evidence a problem. Actually Pockets ( 4 mm or more) are not the problem, but inflammation that can exist at the base of the pocket can cause increase the risk for tooth loss.  An inflamed sulcus provides easier access to bacteria into patients tissues and can cause a host of problems including more bone loss. Also the chemicals associated with the inflammatory process (c-reactive protein, prosthoglandins, cytokines and others) can enter the patients bloodstream and potentiate other health problems. Heart disease, stroke,d iabetes and even cancer are thought by some to be made more likely by periodontal disease.  Probably another significant finding is bleeding upon probing. This is evidenced by bleeding after a periodontal probe is gently introduced into a tooth's sulcus. This sign is the most predictable evidence of sulcular inflammation.

Dentists are on the lookout for "pocketing" because the deepening of the gingival crevice adjacent to a tooth can compromise the life expectancy of it.  Some pockets are evidence of other types of tooth problems such as a fractured tooth or a tooth that needs a root canal. A thorough visual inspection of the patients radiograph and the teeth involved can often help determine what type of pocket a tooth has and help determine a recommendation for treatment.

Often, the treatment for teeth with pockets caused by periodontal disease, consists of root planning , a deep cleaning procedure that helps clean the root surfaces, with the hope that when  root surfaces are made more clean, the adjacent  pockets may shrink or a least  the inflammation around the teeth will diminish. At the same time patients are given instructions on how to care for their teeth and gums at home, using good tooth brushing technique and given instruction on flossing and other techniques for cleaning between teeth (using tooth pics or small interdental brushes). Water piks are often recommended to help clear sulci of bacteria and when used properly,  a patient who water piks has fewer bleeding spots when probed ( and less intra oral inflammation).

Most dentist recommend  a more frequent recall schedule for patients at risk for periodontal disease and after root planning most patients are placed on a periodontal recall schedule ( cleanings every three or four months). Subsequently, these patients should have their mouths reprobed at regular intervals. In my practice we like to record  probing measurements once a year if possible. This allows us to better assess their mouths periodontal health as it changes over time. Interestingly,  patients of longstanding  can be observed to go through periods of periodontal health, worsening health and can be observed to improve again or worsen, depending on a number of factors ( home care, overall immune status and other health issues).

Some patients who are exhibiting inflamed gums , even in the presence of adequate oral hygiene do well  when they are placed on low dose doxycycline therapy (20 mg twice a day) for three to nine months (or more) and return every three months for their cleaning. Often their pocket readings diminish and they have fewer bleeding spots after probing as well. Once periodontal health has been reestablished often they can be weaned off the doxycycline and stay on their three month recall schedule . Afterwards it helps continuously monitor their periodontal health and evaluate their status every three months.

from Ask Dr. Spindel - http://lspindelnycdds.blogspot.com/2018/09/why-does-dentist-perform-perioprobing.html - http://lspindelnycdds.blogspot.com/

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